We read with interest the article by Chen et alv1 on the cost-effectiveness of therapeutic modalities for psoriasis. The authors are to be congratulated for embarking on a much needed study. However, we have substantial concerns about the validity of the analysis.
The results showed that Goeckerman therapy was more cost-effective than liquid methotrexate in severe but not mild or moderate psoriasis. The authors appear to have either entirely omitted or grossly miscalculated the costs of the laboratory evaluations and periodic physician office visits necessary for the appropriate use of methotrexate, as outlined in the guidelines for the use of methotrexate to treat psoriasis.2 Using the current cost figures from Stanford University Medical Center, Stanford, Calif, the annual cost of laboratory tests and level 2 physician office visits is $2020. This figure alone, which does not include the costs of medication and liver biopsy, is higher than the cost of liquid methotrexate therapy used in this study, and is within $346 to $1291 of the cost of tablet methotrexate therapy.
Lim HW, Anderson TF, Douglass M, Koo J, Lebwohl M, Morison W, Taylor C, Zanolli M. Cost-effectiveness of Methotrexate and Goeckerman Therapy: A Flawed Analysis. Arch Dermatol. 1999;135(6):717-718. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-6-dlt0699